The use of indocyanine green navigation in the treatment of a choledochal cyst in a child

In pediatric surgery, near-infrared fluorescence imaging using indocyanine green has become widespread. This report presents a new approach for intraoperative identification of extrahepatic bile duct anatomy during laparoscopic choledochal cyst resection and hepatoduodenostomy formation in a pediatric patient. A 10-month-old girl presented with episodes of restlessness accompanied by vomiting. On prenatal ultrasound, a cystic lesion was detected in the hepatic portal region, and its presence was subsequently confirmed on postnatal imaging. Contrast-enhanced computed tomography and magnetic resonance cholangiopancreatography revealed a Todani type Ib choledochal cyst measuring 2.2×1.6×1.6 cm. For intraoperative fluorescence navigation, indocyanine green (0.25 mg/kg) was administered intravenously 12 hours before surgery. The procedure consisted of laparoscopic cyst resection followed by hepatoduodenostomy creation. Operative time was 120 minutes. Fluorescence imaging clearly delineated the distal margin of the cyst within the pancreatic parenchyma and its proximal extent at the level of the common hepatic duct. Enteral feeding was initiated on postoperative day 2. No intraoperative complications occurred. Postoperatively, the patient showed improvement, with decreased bilirubin levels and liver enzyme activity. No evidence of anastomotic leakage was found during early follow-up. Hospital stay was 7 days. At 6 months of follow-up, the patient had no clinical or laboratory signs of obstructive jaundice or cholangitis. In conclusion, fluorescence imaging with indocyanine green is a safe and highly informative method for intraoperative identification and resection of a choledochal cyst.